This blogpost is a summary of GTG 12 Pregnancy and Breast Cancer. This is an old guideline which was last updated in 2011 but it is one of an important guidelines which is repeatedly tested in exam. This summary is from my personal notes which I prepared for the exam. My purpose to share these notes is to give you an idea “how to summarise a guideline without missing out important information”.
I hope it is helpful. To download full guideline : Click Here
Best wishes as always!!
Background
- Most common cancer in females
- Lifetime risk 1:9 in UK
- Leading cause of death aged 35-54yrs
- 15%→ dx before 45 yrs
- Almost 5000 women affected in reproductive age group in UK annually
- B/w 1991-1997→ 1.3-2.4 cases per 10 000 live births
- If diagnosed ≤30 yrs→ 10-20% may be associated with pregnancy + up to 1 yr postpartum
- Prognosis→ improving
- 5-yr survival→ 80% for under 50 yrs (survival rate may be lower in very young)
- Fewer than 10% diagnosed will become pregnant
- Number of women seeking pregnancy after t/m is increasing
What is optimal management if diagnosed during pregnancy?
Prognosis
- Pregnancy itself doesn’t worsen the prognosis
- As pregnancy associated cancer occurs in younger→ so may have poor prognosis
Diagnosis
- Breast lump + pregnancy→ Refer to breast specialist team
- Any imaging or further tests must be in conjunction with MDT
- USG is used first for discrete lump but if cancer is confirmed, Mammography is necessary to assess extent of disease & contralateral breast
- Tissue diagnosis→ USG-guided biopsy for histology (*not cytology)
- Histology → similar to age-matched non-pregnant. Grade, receptor status & HER2 → for t/m planning
- Staging for metastasis→ only done if high clinical suspicion. Includes→ CXR + liver USG
- Not Recommended
- Gadolinium enhanced MRI
- Tumour marker CA125, CEA & CA15-3